Dapagliflozin question

[JTF04]

Hi. I was wondering if anyone knew how low carb is safe on dapagliflozin? I've recently had this added to my regime after diet and metaformin appear to have stopped working and readings had spiralled back to late teens/20.Rapid weight loss/ constant thirst were all back too. Leaflet for dapagliflozin said risk of DKA so I stopped keto and aimed instead for below 100 g carbs a day (diet advice was just eat a healthy balanced diet from DN). Readings now in 10-12 range after 6 weeks of taking this so better but still not good so wondering if safe to go lower carb than that? Weight loss has stopped again but headache and thirst still there. I'm not very active but have dogs so do walk every day. Anyone using this who is in the target range got any advice on what they do to stay there?

 

[Antje77]

after diet and metaformin appear to have stopped working and readings had spiralled back to late teens/20.Rapid weight loss/

Were you still following a low carb diet when your numbers went back up to high teens and twenties?
Have you been tested for other types of diabetes than T2?

With dapagliflozin it's possible to go into DKA without having very high numbers if you're not producing enough insulin. Can you test for ketones?

 

[EllieM]

I'll tag in @Oldvatr who has some experience of flozins.

Given that you started out with a high hba1c and have only been diagnosed for a year, and low carb has stopped working, I would hope your GP had done the tests to rule out types of diabetes other than T2...

Ps I love your avatar dog picture.

 

[JTF04]

Yes I was still low carb. I thought at first it was carb creep so I tried to be more careful, but it seems once its high it just won't come back down on own. I had eliminated bread, pasta, rice etc tho have reintroduced small portions of wholegrain pasta/ bread now that I'm on dapagliflozin.

 

[JTF04]

I'll tag in @Oldvatr who has some experience of flozins.

Given that you started out with a high hba1c and have only been diagnosed for a year, and low carb has stopped working, I would hope your GP had done the tests to rule out types of diabetes other than T2...

Ps I love your avatar dog picture.

Thanks! That's one of the dogs that keeps me active! Doctor has done tests on heart and thyroid but nothing on types of diabetes. Should I maybe ask if numbers stay at 10-12? I had some trouble getting taken seriously as initially may hba1c had only risen from 42 to 52 and they were quite happy. But I knew from self testing the rise was all at end of period. Its now 77 and there was 3 weeks on the dapagliflozin in there that will have brought it a little down.

 

[Antje77]

Thanks! That's one of the dogs that keeps me active! Doctor has done tests on heart and thyroid but nothing on types of diabetes. Should I maybe ask if numbers stay at 10-12? I had some trouble getting taken seriously as initially may hba1c had only risen from 42 to 52 and they were quite happy. But I knew from self testing the rise was all at end of period. Its now 77 and there was 3 weeks on the dapagliflozin in there that will have brought it a little down.

I would ask for a C-peptide test, which shows how much insulin you're producing.
The problem with flozins is that they can lower your BG even when you don't have enough insulin. Not enough insulin can lead to DKA. One of the alarm bells for DKA is high BG.
So without the high BG there is a higher risk of DKA being misdiagnosed as a stomach flu or such.

Do you have a means to test for ketones?

 

[JTF04]

Thanks Antje77. I will get some ketone tests to check this as I haven't so far and will ask about a c peptide test. Definitely not had that mentioned to me yet.

 

[Oldvatr]

Deffo agree with you seeking c-pep test.

My experiences from the two occasiuons I was made to take Dapa were not exactly happy ones. I did get a eDKA type of episode where my ketones shot up into the warning band (8 mmol/l) but I survived that by drinking lots of water to hydrate myself, If you are weeing copiously still then dehydration may be a signigificant increase in risk for you. The Dapa will make the weeing worse.

I was recently put on Dapa by my heart team, not my GP. I was already in range by using a medium carb diet of around 80- 100g per day, and for me the Dapa did nothing for my sugar levels. That med does need carbs to work properly, and I remember one study that showed low carb was not able to trigger the correct enzymes needed for boosting the insulin output. Hence eDKA due to insulin deficiency, I presume.

 

[mansingh01]

Hi. I was wondering if anyone knew how low carb is safe on dapagliflozin? I've recently had this added to my regime after diet and metaformin appear to have stopped working and readings had spiralled back to late teens/20.Rapid weight loss/ constant thirst were all back too. Leaflet for dapagliflozin said risk of DKA so I stopped keto and aimed instead for below 100 g carbs a day (diet advice was just eat a healthy balanced diet from DN). Readings now in 10-12 range after 6 weeks of taking this so better but still not good so wondering if safe to go lower carb than that? Weight loss has stopped again but headache and thirst still there. I'm not very active but have dogs so do walk every day. Anyone using this who is in the target range got any advice on what they do to stay there?

I d would invest in some testing strip to see what carbs increase Yr reading. Because you urine a lot you will fell thirsty and tired so you need to replace liquid but not with full sugar drinks

 

[Antje77]

Thanks Antje77. I will get some ketone tests to check this as I haven't so far and will ask about a c peptide test. Definitely not had that mentioned to me yet.

Sometimes doctors and practice nurses forget that there are more types of diabetes because they mainly deal with T2's.